•目的前瞻性评估TUPS(经尿道前列腺手术)后早期尿液分析变化和细菌尿的临床相关性。•方法前瞻性评估参加TUPS的BPO患者。患者在术后2、4、8、12和24周通过DVAS(排尿困难视觉模拟量表)进行评估,IPSS-QOL,尿流,PVR。在出院前和所有就诊时进行常规尿液分析。出院前进行MSUC(中段尿培养),术后4周和12周。•结果在最终分析中,152名患者是可评价的。据报道,52%的患者有明显的脓尿,96.1%,94.1%,71.7%,出院前78.9%和52.5%,2-,4-,8-,12-,术后24周尿液分析。非显著脓尿的平均时间(95CI)为19.1(17.5-20.7),20.1(17.3-22.9),前列腺切除术后15.8(12.8-18.8)和14(10.3-17.8)周,汽化,摘除,和切口,(P0.03)。不管TUPS技术如何,一半的患者在术后24周有显著的脓尿.MSUC在37/152(24.3%)中呈阳性,3/152(2%),23/152(15.1%),和5/152(3.3%)术前,出院前,分别为术后4周和12周。只有术前尿白细胞酯酶阳性独立预测4周MSUC阳性(OR3.8,95CI1.3-11.1,P0.013)。在不同随访时间点,IPSS或DVAS与MSUC阳性之间以及IPSS与术后脓尿之间均无明显相关性(P>0.05)。然而,2周尿液分析显示术后排尿困难程度与术后脓尿计数显著相关(r0.69,P0.03),8周(r0.26,P0.001)和12周(r0.23,P0.004)。•结论TUPS术后6个月有持续但逐渐下降的脓尿和微血尿。前列腺切开和摘除后注意到较早的分辨率。虽然这几个月的尿常规分析筛查没有明确的临床价值,术后1个月进行常规尿液培养具有合理意义.
Objective: To prospectively assess early post-
transurethral prostate surgery (TUPS) urinalysis changes and bacteriuria with its clinical relevance. Methods: Patients with benign prostate obstruction enrolled for TUPS were prospectively assessed. Patients were assessed at 2, 4, 8, 12, and 24 weeks postoperatively by the dysuria-visual-analogue-scale (DVAS), international prostate symptom scores (IPSS)-quality of life, uroflow, and postvoid residual. Routine urinalysis was performed before discharge and at all visits. Midstream urine culture (MSUC) was performed before discharge, and 4 and 12 weeks postoperatively. Results: At final analysis, 152 patients were evaluable. Significant pyuria was reported in 52%, 96.1%, 94.1%, 71.7%, 78.9%, and 52.5% in, before discharge, 2-, 4-, 8-, 12-, and 24-week urinalysis postoperative, respectively. The mean time to nonsignificant pyuria (95% confidence interval [CI]) was 19.1 (17.5-20.7), 20.1 (17.3-22.9), 15.8 (12.8-18.8), and 14 (10.3-17.8) weeks after prostate resection, vaporization, enucleation, and incision, respectively (p = 0.03). Regardless the TUPS technique, half of patients had significant pyuria at 24 weeks postoperative. MSUC was positive in 37/152 (24.3%), 3/152 (2%), 23/152 (15.1%), and 5/152 (3.3%) preoperatively, before discharge, and 4 and 12 weeks postoperative, respectively. Only positive preoperative urine leukocyte esterase independently predicted positive 4-week MSUC (odds ratio 3.8, 95% CI 1.3-11.1, p = 0.013). No significant correlation was found between IPSS or DVAS and positive MSUC, nor between IPSS and postoperative pyuria at different follow-up points (p > 0.05). However, the degree of postoperative dysuria was significantly correlated with postoperative pyuria count by urinalysis at 2 weeks (r = 0.69, p = 0.03), 8 weeks (r = 0.26, p = 0.001), and 12 weeks (r = 0.23, p = 0.004). Conclusion: There is a persistent but gradually declining pyuria and microhematuria following TUPS up to 6 months postoperative. An earlier resolution was noted following prostate incision and enucleation. While routine urine analysis screening in these months would be of no clear clinical value, a routine urine culture would be of a reasonable significance at 1 month postoperatively.